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ACTIVE AGING

HL Dhar*

*Director Research, Medical Research Centre, Bombay Hospital, Mumbai 400 020.


Aging is a fact of life. As age advances man is prone to all types of disorders, however, with remedial measures at appropriate time he can lead an active life till end.

Physical fitness is the key factor but sound mental health, social well being and independent economic status are necessary to lead active and contented life as age advances. Although dietary regulation is the primary need, routine exercise, improved family relation and relation to the society and community are complimentary. Regular practice of meditation contributes to physical, mental and social well being, reverses the aging process and coordinates all round quality of life.

Aging is a fact of life which does not take place all of a sudden. It is fixed and definite for all individuals in the normal course of a life time and death is the end result of old age. Although elders are prone to all types of disorders, it is possible to take remedial measures which would enable one to lead a happy and contented life.

In order to lead an active life as age advances, proper planning is essential right from the middle age itself so as to have good physical and sound mental health along with social harmony. It is unusual to find an elderly subject who has a physical illness but has not affected his mental and social states. [1]

Physical fitness

Physical fitness is the key factor in old age. In order to have active aging the first and foremost requirement is to achieve a state of good health which primarily depends on the following factors.

Balanced diet and nutrients

Individual aging is influenced primarily by a personís genetic make up (predetermined and constant), life style (optional and variable) and environmental factors. It is possible to change life style primarily adjusting to balanced diet and improving the environmental conditions including personal hygiene.

Diet

Balanced diet plays an important role in slowing aging process. [2-5] In general, the diet of the old person should be continuation of those consumed in adult life but less quantity and supplemented with vitamins and minerals. As age advances body loses muscle and gains fatty tissue requiring less intake of food. Overall intake is reduced by 15% from age 45 to 55 years and thereafter 10% each decade. [1] Balanced diet has been shown to prevent or reduce the incidence of common diseases [4,6] including heart diseases. [7] Several studies have shown that natural antioxidants (e.g. Vit A, Vit E, Vit C) are modifier of colon cancer [8] and might be contributory in delaying aging process. Infection can adversely affect nutrition. It results in malnutrition, which can predispose to infections by adverse effect on immunity. [9] Recently it has been shown that vegetarian diet (fruits and vegetables) decreases the overall risk of various diseases. [10] Very recently Joshi and Dhar [11] have studied nutritional requirement in Indian elderly showing upper middle class people of Bombay consume 1869 calories and that they consume enough vitamins except B1, B2, B7 and B12 and minerals except zinc which were marginally low. Based on this findings and earlier works [12] average calorie requirement in Indian elderly has been shown in Fig. 1. A simplified version of daily food intake in elderly subjects has been shown in the form of a pyramid (Fig. 2).

Exercise

Physical exercise is essential in old age as age advances, blood circulation gradually declines which affects the proper functioning of all organs. Regular exercise improves circulation and helps to maintain normal function. Exercise improves lung function [13-15] and beneficial in hypertension, anxiety, neurosis and bronchial asthma [16,17] and reduces heart disease. [7] Sweat centre is depressed in elderly subjects and sweating is not an indication of adequate exercise in elderly. Brisk walking for a period of 45 minutes to one hour is an ideal exercise for elderly subjects.

Fig 1 Fig 2
Fig 1
Fig 2

Periodical health checkup

Elderly subjects usually suffer from multiple pathology and periodical health check up is a must. [18,19] Community survey in Great Britain has shown that 14% of otherwise normal elderly subjects suffer from borderline congestive cardiac failure and hypertension. [20,21] As one grows old, the body undergoes a lot of changes and these may be indicated by decline in appetite, weight loss, lack of sleep and memory loss etc. [19] These symptoms may be due to the normal process of aging or sometimes they may be indicative of diseases like TB, diabetes, cancer etc. If such diseases are identified at an early stage it is possible to provide suitable treatment with better patient outcome. However, sudden loss of weight, cough with change in voice, difficulty in swallowing, intermittent fever, chronic pain, enlargement of mole, lump in the breast or elsewhere and internal bleeding should be immediately reported to the doctor. [22]

Environment and personal hygiene

Elderly subjects are susceptible to infection and maximum death results from respiratory infection particularly bronchopneumonia. Many infections prop up due to unhygienic conditions and elderly subjects are more liable to catch infection from infected food stuff, water, filthy surrounding and indifference or inability to use clean clothings. [23,24]

Mental and social well being

A sound mind can exist only in a sound body however, mental health is dependent on social harmony, family relation and sound or independent financial status. But loneliness is a deadly enemy during old age.

As age advances the cells in the brain start declining gradually. This results in memory loss and other mental disorders [19] which can be avoided or reduced by active involvement either in work or in recreation e.g. reading books, listening to radio or mixing with friends and relatives.

Elders can play an important role in ensuring harmony in their relationship with family and society. They should understand the domestic situation, occupation and economic problem of the youngsters and adjust their attitude accordingly to ensure peace in the family. They can involve themselves in small chores, like taking grand children to school, shopping, paying electric and phone bills etc. Such assistance will be appreciated by the youngsters and ensure due respect and affection for the elders. [25] The spare time can be devoted in social activities. Social work can be created, if outdoor activities are not possible one can analyse TV serial and create public opinion on merits and demerits of such serials.

Financial status

A comfortable or independent financial status contributes to mental satisfaction, physical care and improved family and social harmony. Number of elderly people may have financial difficulties which often start around the period of retirement, as they pass from an economically productive state to an economically non productive and dependent state. This is when the process of worry begins. Even if the person does not worry consciously about future, unconsciously these thoughts undermine his sense of confidence. He becomes more and more conscious about money and reluctant to part with it and gradually becomes more and more isolated from the community. [2,18]

Hence right from the middle age, one should take adequate steps to ensure a comfortable financial status in old age. They should make it a point to retain their property and wealth in their own name till death and should have regular saving accounts in a nearby bank.

Sex, aging and health

Gerontologists and other medical experts generally agree that continued sexual interest and activity can be therapeutic for old men and women. Sexual activity seems to have a protective effect on menís health. In a cohort study, mortality risk was found to be 50% lower in men with high frequency of orgasm. There is evidence of dose response relationship. [26] In fact "sexual capabilities in the elderly is a significant measure of their aging". [27]

No doubt sexual desire diminishes as age advances but many men remain sexually active even after the age of eighty. However, biologically womenís sexuality is less affected by age than manís. She enjoys sexual activities till the end of her life. [28]

Loneliness and solitude

Loneliness is a deadly enemy in old age. Research has shown that senility is six times faster in a person who is isolated and withdrawn from the society. [25] They become more and more isolated, depressed and there is an increased tendency to commit suicide.

Loneliness should be differentiated from solitude. In solitude, one is able to turn to the spiritual self and in the company of that spiritual inner being, one never feels lonely.

Meditation health and aging

Meditation is a vedic exercise used since time immemorial as a powerful tool to restrain sense organs and attain the state of superconsciousness. [29] However, scientific evidence of its effect on health and disease is quite recent. In recent years Transcendental Meditation (TM) has been shown to reduce anxiety, decrease hospitalization, improve intelligence and performance. [30] However, it has been demonstrated that regular practice of TM 20 minutes in the morning and evening reverses the aging process (Fig. 3). It is of particular interest of elderly subjects to practise meditation

Fig 3
Fig 3

which will take care of insomnia so common during advancing age and that it converts loneliness to solitude [19] the ultimate source of all happiness. Detail studies on meditation is under publication. [31]

Longevity and aging

Active aging means active life span, longevity on the other hand indicates increased life span. However, there is no meaning of increased life span unless it is also active. Animal (rodents) studies have shown that modifying the dietary amount of calories, protein and fat can influence survival in these species. [32] In human however, there have been no studies to indicate that special dietary manipulation will extend the human life span beyond the maximum of approximately 110-120 years.

Recent studies like activation of immune system with dihydroepiandrosterone (DHEA) an adrenocortical hormone in man and anticipation of anti oxidant therapy contributing to increased life span are encouraging. [32] However, practice of mediation particularly TM along with modified and balanced diet might be contributory. [33]

REFERENCES

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  33. Joshi SV, Dhar HL. Meditation, reversal of aging and active life span. (On going research, Gerontology) Medical research centre, Bombay Hospital Trust.

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